Strategies for CABG patients with carotid artery disease and perioperative neurological complications

Postoperative neurological complications not only increase morbidity and mortality, but also prolong hospital stay and elevate hospital costs. From 1995, carotid artery duplex scanning (CADS) has been performed in our hospital as screening for cerebrovascular disease in patients undergoing nonemergency coronary artery bypass grafting (CABG). This study was designed to evaluate the usefulness of our strategy for preventing stroke during CABG. Between 1995 and 1997, 179 patients underwent isolated CABG. Of the nonemergency CABG patients, 146 underwent preoperative CADS. Three patients underwent a combined carotid endoarterectomy (CEA)/CABG procedure. One hundred and thirteen patients were men (77.3%), and the median age was 64, with a range of 39-82 years. The mean graft number was 2.7 +/- 0.9. Previous neurological events had occurred in 12 patients. Forty-five patients (30.8%) had abnormal CADS findings. Two (1.4%) of these patients had carotid stenosis > or = 90% in area, and five had total occlusion of the carotid artery. When the risk factors were evaluated, age and previous cerebrovascular disease (CVD) were found to be significantly higher in the group with abnormal CADS findings (P = 0.0012 and P = 0.0312). On multivariate analysis, the predictor of abnormal CADS findings were age and previous CVD (P < 0.01 and P < 0.05). Six patients (3.3%) developed postoperative stroke due to emboli (five cases) or perioperative hypoperfusion (one case). Three patients who underwent the combined CEA/CABG procedure did not suffer from any neurological complications. Preoperative screening by CADS is helpful for evaluating the presence of carotid artery disease in patients undergoing CABG. Further investigations to clarify the carotid hemodynamics are important, and synthetic assessment will be required to determine the most appropriate operative strategy.